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WO2003071380A3 - Sequencing models of healthcare related states - Google Patents

Sequencing models of healthcare related states Download PDF

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Publication number
WO2003071380A3
WO2003071380A3 PCT/US2003/003296 US0303296W WO03071380A3 WO 2003071380 A3 WO2003071380 A3 WO 2003071380A3 US 0303296 W US0303296 W US 0303296W WO 03071380 A3 WO03071380 A3 WO 03071380A3
Authority
WO
WIPO (PCT)
Prior art keywords
metrics
states
models
healthcare
doctors
Prior art date
Application number
PCT/US2003/003296
Other languages
French (fr)
Other versions
WO2003071380A2 (en
Inventor
Nallan C Suresh
Traversay Jean De
Hyma Gollamudi
Krassimir G Ianakiev
Anu K Pathria
Michael K Tyler
Original Assignee
Fair Isaac And Company Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Fair Isaac And Company Inc filed Critical Fair Isaac And Company Inc
Priority to AU2003212916A priority Critical patent/AU2003212916A1/en
Publication of WO2003071380A2 publication Critical patent/WO2003071380A2/en
Publication of WO2003071380A3 publication Critical patent/WO2003071380A3/en

Links

Classifications

    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
    • G16H40/20—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q10/00—Administration; Management
    • G06Q10/10—Office automation; Time management
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
    • G06Q40/08—Insurance

Landscapes

  • Business, Economics & Management (AREA)
  • General Business, Economics & Management (AREA)
  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Epidemiology (AREA)
  • General Health & Medical Sciences (AREA)
  • Medical Informatics (AREA)
  • Primary Health Care (AREA)
  • Public Health (AREA)
  • Medical Treatment And Welfare Office Work (AREA)
  • Management, Administration, Business Operations System, And Electronic Commerce (AREA)

Abstract

Transition probability sequencing models and metrics are derived from healthcare claims data (100, Fig.1) to identify potentially fraudulent or abusive practices, providers, doctors, clients, or other entities. Healthcare reimbursement claims from hospitals, skilled nursing facilities, doctors, etc., are processed to identify sequences of states, and transition probability metrics are determined from frequency information pertaining to the states. The metrics can these be further analyzed in predictive (4, Fig.1) or rule based models (5, Fig.1), or other tools.
PCT/US2003/003296 2002-02-15 2003-02-04 Sequencing models of healthcare related states WO2003071380A2 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU2003212916A AU2003212916A1 (en) 2002-02-15 2003-02-04 Sequencing models of healthcare related states

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US10/076,961 2002-02-15
US10/076,961 US7263492B1 (en) 2002-02-15 2002-02-15 Sequencing models of healthcare related states

Publications (2)

Publication Number Publication Date
WO2003071380A2 WO2003071380A2 (en) 2003-08-28
WO2003071380A3 true WO2003071380A3 (en) 2003-12-04

Family

ID=27752679

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2003/003296 WO2003071380A2 (en) 2002-02-15 2003-02-04 Sequencing models of healthcare related states

Country Status (3)

Country Link
US (2) US7263492B1 (en)
AU (1) AU2003212916A1 (en)
WO (1) WO2003071380A2 (en)

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US8880487B1 (en) 2011-02-18 2014-11-04 Pegasystems Inc. Systems and methods for distributed rules processing
US9195936B1 (en) 2011-12-30 2015-11-24 Pegasystems Inc. System and method for updating or modifying an application without manual coding

Also Published As

Publication number Publication date
AU2003212916A8 (en) 2003-09-09
US20070271120A1 (en) 2007-11-22
US7778846B2 (en) 2010-08-17
WO2003071380A2 (en) 2003-08-28
US7263492B1 (en) 2007-08-28
AU2003212916A1 (en) 2003-09-09

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